A Tactical Approach To Scene Safety

Practical tips for EMS providers on handling potentially violent patients and unsafe scenes


     Every month there seems to be another EMS provider assaulted or even killed in the line of duty. Why? Is it because there are more violent and unstable situations? Or are we simply unaware and leaving ourselves vulnerable?

     The answer lies with each EMS provider:

  1. Do you routinely perform weapons searches (pat-downs) on all your patients?
  2. Do you ask your patients if there's anything in their possession that may harm them or you?
  3. Have you ever transported a patient's belongings in a bag without knowing the exact contents?
  4. Have you ever encountered a situation on a call that caused you to feel uncomfortable regarding your personal safety? Was law enforcement present?
  5. Have you ever been involved in a close call?

     If you answered yes to any of these questions, then it's safe to say your scene choreography may have left you unaware of an unsafe situation, and therefore vulnerable.

SCENE SAFETY

     What is scene safety? Are EMS providers taking appropriate precautions and fully aware of potential hazards on every scene? Any scene has a potential for violence, and many have not-so-obvious indicators of danger. Just as we proceed as if all our patients have bloodborne pathogens, we should respect all patients as having the ability to become violent, cause an unsafe situation or intentionally injure someone.

     Personal safety should be your primary concern on every call, regardless of the call's acuity. Our goals on every call are patient compliance and scene control, both of which directly affect safety. Safety awareness is something that should be applied to every aspect of each call, from dispatch through completion. In this article we will focus on applying safety awareness to every patient approach and assessment.

TACTICAL APPROACH, ASSESSMENT

     A tactical patient approach and assessment includes self-awareness, situational awareness, patient awareness and environmental awareness. It requires being assertive, as appropriate, and helps you develop the ability to protect yourself and others. It necessitates appropriate verbal engagement (see the book Verbal Judo by George Thompson and Jerry Jenkins) and simple physical strategies to survive. It demands a position of superiority at all times. It's about looking, sounding and acting like a professional.

     There are four main components to total safety awareness:

  • Self-awareness is being cognizant of your own actions (posture, stance, hand position and gestures) and communication (tone, dialect, speed and demeanor). Learn to be conscious of items on your person that may be used as weapons, either against you or by you. Know your vulnerabilities, strengths and weaknesses, and what can potentially set you off.
  • Patient awareness is respecting that a patient possesses the ability to harm you, and may have a weapon until proven otherwise. This includes rapid evaluation of the patient's actions and communications.
  • Situational awareness is awareness of the circumstances around the EMS encounter. What are the patient's thoughts, perceptions and beliefs?
  • Environmental awareness includes the conditions of the scene. What parties are in attendance, both visibly and out of sight? What is within the patient's reaching distance, and what are the potential risks and hazards?

APPROACHING THE PATIENT

     The manner in which you approach the patient is a critical step in ensuring safety and allowing for a productive interview. First, the patient's location can give them a psychological advantage. If a patient presents in their residence, outside or inside, it's their domain—you cross a boundary into it. People have different beliefs, rules and manners that guide their actions within their property and personal space.

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